3.1 The committee
received a report explaining the error in the despatch for the
November Health and Wellbeing Board (HWB) meeting which meant that
it was not possible for the committee’s referral on changes
to sexual health services in the borough to be considered by the
HWB at its November meeting.

3.2 It was explained
that the error was due to an oversight in the relevant team and
that all staff have since been reminded of the importance of
following due process and utilising systems for the effective
management of agendas and reports. Managers will also continue to
support staff learning and development.

Resolved: the committee agreed to refer its views on
the health visiting element of the proposed public health grant
cuts in the following terms:

The Healthier Communities Select Committee notes the
Mayor’s manifesto pledge to continue to give the highest
priority to our children and family services and to ensure all our
young people – no matter what their background or challenges
– achieve their potential and thrive. Having heard the
responses to the public consultation on public health cuts,
specifically health visiting cuts, the committee is concerned about
the impact the proposed cuts would have on current and future life
experiences of children and young people in Lewisham. The committee
therefore asks Mayor & Cabinet to make its decision on the
proposed cuts to health visiting services having regard to these
points and the evidence produced on health visitor to children
ratios in paragraphs 11.21 to 11.33 of the Mayor & Cabinet
report on these cuts.

Minutes:

Catherine Mbema (Acting
Consultant in Public Health), James Lee (Service Group Manager,
Prevention, Inclusion and Public Health Commissioning), and
Catherine Bunten (Service Manager, CYP Joint Commissioning)
introduced the report. The following key points were
noted:

4.1 The Government will
be making a further cut to the Public Health grant to local
authorities for 2019/20. In Lewisham, the cut for 2019/20 will be
£642,000. This will reduce the grant for 2019/20 to
£23,683,000.

4.2 In response to the
cuts the Council carried out a range of consultation activity as
part of an overall 15-week consultation process. The officer report
included in the agenda papers presents the findings of the
consultation activity.

4.3 The vacancies within
the health visiting workforce are reflective of nationwide vacancy
rates. If there were no vacancies officers would explore other
areas, such as staffing structure, in order to make the
cuts.

4.4 Officers noted that
they will need to work closely with Lewisham and Greenwich NHS
Trust in order to complete all mandatory health visiting checks and
consider in the future carrying out some of the checks in group
settings. Officers would always recommend, however, that children
within the targeted caseload have such checks in their
home.

4.5 A member of the
public, representing the Save Lewisham Hospital Campaign, addressed
the committee. They noted that the first 100 days of a
child’s life are critical to determining health and wellbeing
and asked the Council to look at all possible alternatives to the
proposed cut to health visiting services.

4.6 The committee expressed
concern about long-term vacancies in the health visiting workforce,
noting that the population in Lewisham is expected to grow
substantially and that health visitors may be the only
professionals that see some very young children. The committee
noted its concern about any future reduction of the health visiting
service.

4.7 The committee
expressed concern about the different figures for estimated health
visitor caseload ratios being referred to by officers and members
of the public and asked officers to seek clarification before
presenting its report to Mayor and Cabinet.

5.1 Lewisham is
currently one of the best performing hospitals in London against
the four-hour A&E waiting time target.

5.2 While winter does
not always lead to increased attendance at the emergency
department, there tends to be an increase in people requiring
admission.

5.3 Improving patient
flow is one of the main aims of this year’s winter
planning.

5.4 Patient activity and
treatment will be monitored more closely to ensure a productive
stay in hospital.

5.5 Plans for discharge
will begin from the day patients come in, with better coordination
among hospital teams and with the local authority.

5.6 The hospital will
work with care homes to support them to treat patients without
having to bring them into the emergency department.

5.7 The hospital is
considering a criteria-led discharge process, which would involve
doctors talking to their teams and setting criteria for patients to
be discharged, rather than doctors having to be there to sign-off
the discharge of every patient on the day of their
discharge.

5.8 A “crisis
café” will open on the Lewisham hospital site to
provide a calmer environment and take referrals from the emergency
department for patients with mental health issues. This is being
created in conjunction with the local mental health trust and third
sector partners with funding from NHS Improvement.

5.9 It was noted that
due to the pressure on the London and national mental health system
there had been a number of occasions where there had not been any
free mental health beds in the country.

5.10
Workforce is the biggest challenge for the hospital, with, for
example, a higher number of nurse vacancies than it would
want.

The committee asked a number of questions. The
following key points were noted:

5.11 The
committee queried if any of the 23 patients with mental health
issues who had exceeded a 12-hour wait were children. Officers from
the hospital said that this would be highly unlikely but agreed to
check the figures and provide a response. (The Trust responded post
meeting to confirm that all of these patients were
adults).

5.12 The
committee queried the potential risks of a criteria-led discharge
process and what could be done to mitigate these.

5.13 The
hospital stressed that the only way that a criteria-led discharge
process will work in practice is if doctors are fully behind it.
Criteria-led discharge has been put in place in other areas by
being clear about what the specific criteria are. The hospital
would also closely monitor the impact on readmission
rates.

Resolved: The committee noted the report, welcomed
the decision of the LGT Board to step out of the southeast London
private/public partnership in order to maintain a 100% NHS
contract, and asked to be informed when a decision about the
network partners is made.

Minutes:

Lynn Saunders (Director of
Strategy, Business and Communications, LGT) introduced the report.
The following key points were noted:

6.1 There is a national
drive to change the way pathology services are provided across the
country. All pathology services in England are expected to be
joined in networked services. Lewisham and Greenwich NHS Trust
(LGT) was advised that is was expected to be part of the southeast
London network.

6.2 Pathology services
at LGT are provided differently to local partners such as
Guy’s and St Thomas’ (GSTT) and King’s College
Hospital. The GSTT and King’s service is a joint venture with
a private sector partner, which has been running for 10 years, but
is due to expire towards the end of 2020. The LGT service is run
entirely within the NHS.

6.3 The potential value
of pathology services in southeast London would be £2.25bn
over 15 years. LGT wanted to see an NHS option developed and given
equal consideration. However, there were no NHS providers
interested in taking on such a large contract.

6.4 LGT decided
therefore to explore other NHS networks that it could be part of.
LGT is now working with Barts Health
and South West London Pathology and is expecting to make a decision
by the end of January 2019 to determine which network it will
join.

6.5 A key consideration
for LGT is the provision of pathology services to GPs. LGT
currently provides pathology services to all GPs in Greenwich,
Bexley, and Lewisham and for Oxleas Trust. However, Clinical
Commissioning Groups (CCGs) and GPs are currently part of the
southeast London procurement process. LGT intends to work with
their CCG colleagues to find the best solution for the borough and
hopes to continue providing services for GPs, which will maintain
the important clinical links between GPs and local hospital
clinicians.

Aileen Buckton (Executive
Director for Community Services) and Sarah Wainer (Programme Lead,
Whole System Model of Care, Lewisham CCG) introduced the report.
The following key points were noted:

7.1 On 21st
November 2018 Mayor & Cabinet approved the proposal to formally
integrate a number of social care and health services that support
adults in their own homes to improve the quality of service
provision.

7.2 This includes the
Council entering into a Section 75 (NHS Act 2006) agreement with
Lewisham and Greenwich NHS Trust (LGT) and, in the future, South
London and Maudsley NHS Foundation Trust (SLaM).

7.3 Although the formal
agreement is only between LGT and the Council, there will be close
working with other partners, including in the voluntary
sector.

7.4 The integration of
services is intended to break down the barriers between different
professionals working in people’s homes and to ensure that
people cared for in their homes are central to way in which they
work.

7.5 Every local
authority in England has to have proposals on how it is going to
integrate with its health partners by 2020.

7.6 The full business
case for the proposals has been to the Lewisham Health Care
Partners and the new arrangements are expected to be in place by
1April 2019.

The committee made a number of comments. The
following key points were noted:

7.7 The committee noted
concerns over the stability of the care sector and asked about the
plans to mitigate these risks.

7.8 The committee were
informed that the proposals seek to work with the care sector to
support and develop it further and to look at training
opportunities to make it more attractive for staff.

9.1 The Scrutiny Manager
agreed to arrange the site visit to the Lewisham Hospital Crisis
Café and to notify other members who may be
interested.

10.

Referrals to Mayor and Cabinet

Minutes:

Resolved: the committee agreed
to refer its views on item 4, Public health grant cuts
consultation, in the following terms:

The Healthier Communities Select Committee notes the
Mayor’s manifesto pledge to continue to give the highest
priority to our children and family services and to ensure all our
young people – no matter what their background or challenges
– achieve their potential and thrive. Having heard the
responses to the public consultation on public health cuts,
specifically health visiting cuts, the committee is concerned about
the impact the proposed cuts would have on current and future life
experiences of children and young people in Lewisham. The committee
therefore asks Mayor & Cabinet to make its decision on the
proposed cuts to health visiting services having regard to these
points and the evidence produced on health visitor to children
ratios in paragraphs 11.21 to 11.33 of the Mayor & Cabinet
report on these cuts.